Showing papers by "Steve Goodacre published in 1999"
TL;DR: height of fall is a poor predictor of major injury, and the low prevalence meant that, despite impressive specificity at higher thresholds, positive predictive value was poor.
Abstract: Background: After a fall, the distance fallen is sometimes used to predict the injury severity. We aimed to examine how distance fallen performs as a predictor of major injury. Method: A cohort of trauma victims attending our emergency department after having fallen from a height was identified retrospectively, and data were collected regarding the fall and injuries sustained. Performance of threshold heights, ranging from 2 meters (6.6 feet) to 10 meters (32.8 feet), as a diagnostic test for major injury was assessed. Results: Height fallen performed poorly over the range of thresholds used. At low thresholds, sensitivity was inadequate to rule out major trauma, whereas the low prevalence meant that, despite impressive specificity at higher thresholds, positive predictive value was poor. At the optimal threshold of 5 meters (16.4 feet), the positive predictive value was 0.17 and sensitivity was 0.33. Conclusion: Height of fall is a poor predictor of major injury.
51 citations
TL;DR: Audit of nurse triage categorisation by senior medical staff performing case note review has only fair to moderate consistency between reviewers, resulting in frustration among those whose performance is being audited if they recognise inconsistency in the standard they are compared against.
Abstract: OBJECTIVES: To determine the level of agreement between senior medical staff when asked to perform retrospective case note review of nursing triage decisions, both before and after development of a consensus approach. METHODS: Four medical reviewers independently allocated triage categories to 50 emergency department patients after review of their case notes. They were blind to the identity of the triage nurse and their triage categorisation. The process was repeated twice, firstly after agreement on a consensus approach and then using formal guidelines. RESULTS: Agreement between reviewers was initially fair to moderate (kappa = 0.27 to 0.53). This failed to improve after development of a consensus approach (kappa = 0.29 to 0.57). There was a trend towards better agreement when guidelines were used but agreement was still only moderate (kappa = 0.31 to 0.63). CONCLUSIONS: Audit of nurse triage categorisation by senior medical staff performing case note review has only fair to moderate consistency between reviewers. Use of this technique will result in frustration among those whose performance is being audited if they recognise inconsistency in the standard they are compared against.
48 citations